CMV infection: Trends, clinical presentations, and treatment

The incidence of cytomegalovirus (CMV) disease has decreased dramatically as a result of the use of HAART in HIV-infected patients and the use of antiviral prophylaxis in solid organ transplant (SOT) recipients. In patients with HIV infection, the retina is still the organ most commonly affected by CMV, whereas in SOT recipients, the transplanted organ is the most common site of infection. The identification of CMV by histopathology is the most definitive diagnostic finding. Ganciclovir remains the mainstay of treatment. High-dose acyclovir, valacyclovir, and ganciclovir are used for CMV prophylaxis. Valganciclovir has been approved for prophylaxis in kidney, kidney-pancreas, and heart transplant recipients who have donor-positive/recipient-negative CMV serostatus. The combination of foscarnet and ganciclovir may be used to treat ganciclovir-resistant CMV infection in SOT recipients and CMV CNS infection in HIV-infected patients.